Improving the recruitment and retention of Domiciliary Care
workers in Wales
Consultation response form
Your name: Lisa Turnbull
Organisation (if applicable): Royal College of Nursing
Email: lisa.turnbull@rcn.org.uk (for correspondence only)
Address or postcode: Royal College of Nursing, CF14 4XZ
You can let us know about your views by answering one, a few or all of the
questions below. Please send your response by 5 April 2016.
About your interest in domiciliary care
Please let us know if you are:
Someone who uses domiciliary care and support
A carer, a friend or a family member of someone who uses
domiciliary care and support
Yes/no
No
No
Someone who works in domiciliary care – please use the box below to tell us what
job you do:
Someone who works in health or social care – please use the box below to tell us
what job you do:
Someone who has an interest in health and social care, which is not included
above - please use the box below to tell us what your interest is
The Royal College of Nursing is the world’s largest professional union of nurses,
representing 430,000 nurses, midwives, health visitors, health care support
workers and nursing students, including over 25,000 members in Wales. RCN
members work in a variety of hospital and community settings in the NHS and the
independent sector. The RCN works locally, nationally and internationally to
promote standards of care and the interests of patients and nurses, and of nursing
as a profession. The RCN is a UK-wide organisation, with its own National Boards
for Wales, Scotland and Northern Ireland. The RCN is a major contributor to
nursing practice, standards of care, and public policy as it affects health and
nursing.
Your views on recruitment and retention
1. Why do you think it might be difficult to recruit domiciliary care workers?
Before responding to specific questions raised in the consultation, we would
like to note that a definition of ‘Domiciliary Care workers’ would have provided
helpful clarification of the scope of this consultation.
The Royal College of Nursing (Wales) believes that there are several key
factors which might affect recruitment of domiciliary care workers. The first
issue is pay: at present, many care roles are not sufficiently remunerated to
attract people to join the domiciliary care workforce. Low pay, in combination
with reports of long working hours and difficult conditions of work, is likely to
have a negative effect in recruitment.
Another issue relates to the fact that domiciliary care workers are drawn form a
limited pool of labour that also provides the workforce for other care support
roles, such as healthcare support workers. The jobs are often offered by
employers with more favourable terms and conditions of employment (e.g. the
NHS).
2. Why do you think it might be difficult to retain domiciliary care workers?
The main issues affecting recruitment - pay, working hours and conditions - are
also important considerations relating to the retention of domiciliary care workers.
In addition, improvements are needed in continuous professional development
(CPD) to allow care workers to progress within their role. Once an employee has
gained some experience as a domiciliary care worker, they are in a better
position to move on to more favourable employment or educational opportunities
(e.g. nurse training).
3. What do you think we can we do to improve the recruitment of domiciliary
care workers?
RCN Wales would recommend several steps to improve the recruitment of
domiciliary care workers. Firstly, employers across the sector must ensure that
pay better reflects responsibilities. The RCN notes the need for a coordinated
approach to pay and conditions to deliver fairness across the wider health and
social care workforce, and indeed the public sector workforce (acknowledging the
ongoing work of the Public Services Staff Commission.
Another important consideration is the need to improve access to continuous
professional development; this would encourage a perception of domiciliary care
work as a long-term career option with opportunities for learning and progression.
The overall offer in terms of pay and conditions should take account of the extra
hours often worked by staff in community healthcare settings, ensure that
appropriate time is given for breaks, and make allowances for extra demands
such as travel time.
4. What do you think we can we do to improve the retention of domiciliary care
workers?
Please see answer 3 above; it is our assessment that addressing these issues
would improve both recruitment and retention, and that it is therefore difficult to
extricate suggestions that would advance one aim and not the other.
Your views on our ideas to limit the use of zero hours
contracts
5. Which, if any, of our ideas below do you think would work in reducing the
negative impacts of zero hours contracts on the quality of domiciliary care
Yes/no
i. Making domiciliary care providers publish the number of hours
of care delivered by care workers on zero hours contracts
ii. Giving all domiciliary care workers the choice about
whether they are employed on a zero hours contract or
a contract with guaranteed hours
OR
Yes
Yes
OR
No
iii. Converting all zero hour contracts to guaranteed hours
contracts after a domiciliary care worker has been
employed for a specific period of time.
What period of time? ……………………………..
OR
OR
iv. Restricting the number of care hours or the percentage
of care hours which domiciliary care providers can
deliver by zero hours contracts.
No
What you do think should be the maximum number of hours
or maximum percentage of care hours? ………….
6. Which, if any, of the following ways could be used to make sure the changes
set out above happen?
Yes/no
i. As part of the inspection process, the Care and Social
Services Inspectorate Wales will make sure domiciliary care
providers are keeping to the rules about the maximum use of
zero hours contracts
ii.
As part of the inspection process, the Care and Social Services
Inspectorate Wales will make sure domiciliary care providers
are not using exclusivity clauses in zero hours contracts.
Yes
Yes
7. What do you think would be the impact of restricting the use of zero hours
contracts?
Please include any views you have on how restricting zero hours contracts
may have a good or bad effect on the quality of care for service users
Non-guaranteed hours contracts are necessary to facilitate the use of staffing
banks and agencies. Scrapping such contracts could impact on the ability of
care commissioners/providers employing bank and agency staff.
Notwithstanding, if good workforce planning were in place (minimising if not
negating the need for the use of non-guaranteed hours contracts) and
progressive flexible working policies were implemented a more stable and
better quality domiciliary care workforce would be enabled.
8. If you have any other ideas on how we can reduce zero hour contracts having
a negative impact on the quality of care please let us know in the box below
See above.
Your views on National Minimum Wage and travelling time
9. Which, if any, of our ideas below do you think would work in making sure
employers pay domiciliary care workers National Minimum Wage?
Yes/no
i.
Provide information to employers and workers on
how National Minimum Wage works in practice.
ii. Make employers keep records on rates of pay, hours
worked (including travelling, training and sleepovers) and
deductions (including uniforms).
iii. Local authority contracts with domiciliary care service
providers should have a requirement for providers to show
how they make sure they pay National Minimum Wage.
iv. Local authority contracts should be clear about the time
allowed for being with the client and the time allowed for
travelling.
Yes
Yes
Yes
No
10. Which, if any, of our ideas below do you think would work to check employers
pay domiciliary care workers National Minimum Wage?
Yes/no
i.
Make the Care and Social Services Inspectorate
Wales include payment of National Minimum
Wage as part of the inspection process
Yes
ii.
Make the Care and Social Services Inspectorate
Wales inform HMRC where domiciliary care
providers are not, or they suspect they are not,
paying National Minimum Wage
Yes
iii.
As part of contract monitoring processes, local
authorities should make providers demonstrate
ongoing compliance with National Minimum Wage
Yes
11. Which, if any, of our ideas below do you think would work to check domiciliary
care providers are giving, and paying for, enough time for domiciliary care
workers to travel between calls?
Yes/no
i.
Local authorities should check domiciliary care providers are
Yes
allowing, and paying for, sufficient time for care workers to travel
between calls
ii.
The inspector - CSSIW - should include time allowed for
travelling as part of the inspection process.
Yes
12. Please use the box below to let us know about any other ideas or comments
on National Minimum Wage or travelling time:
We believe that domiciliary care workers should be paid a “Living Wage”
not the minimum wage.
They should be paid for travelling time. Travel time should not “eat into” the
domiciliary care workers available tie for delivering services.
The time that domiciliary care workers spend with their clients should be
based on their client’s needs, not arbitrary time slots.
Your views on call clipping
13. Which, if any, of the ideas set out below do you think will help prevent call
clipping?
Yes/no
i.
Introduce clarity into the system by making it clear to providers,
care workers and clients how much time should be spent
travelling to a client and how much should be spent with the
client
Yes
ii.
Make sure domiciliary care workers rotas allow enough time to
travel to each call and complete each call
Yes
iii.
Make sure domiciliary care providers pay domiciliary care
workers for the time spent travelling to the client and the time
spent with the client
Yes
14. Which, if any, of the ideas below do you think would work to check call clipping
does not happen and calls under 30 minutes do not take place unless they
meet conditions set out in the Regulation and Inspections of Social Care
(Wales) Act 2016
Yes/no
i.
ii.
iii.
Make providers keep a record of how long care
workers are with clients and how much time is spent
travelling so they know if enough time has been
allocated for the call and enough time has been
allocated for travelling between calls.
As part of the inspection process, check the time given for
calls is enough for care workers to provide the required care
and the travel time is long enough to allow the domiciliary
care worker to travel between calls.
Yes
As part of the inspection process check any calls which last less
than 30 minutes meet the conditions set out in the act.
Yes
Yes
15. Please use the box below to tell us about call clipping and about any ideas you
may have to prevent it from happening
RCN Wales is currently running its 2016 ‘Time to Care’ campaign, which aims to
communicate the concerns of RCN members to Welsh politicians. One of our
priority campaigning issues is to ‘achieve dignity and quality in personal care’. The
Welsh Government must take action to ensure that care visits are not given too
short a time limit.
In principle we support the proposals contained within this consultation, which aim
to ensure that the actual amount of time given to care would be identified. We
would appreciate further detail on these suggestions should they be progressed
further.
However, caution should be advised to ensure that any changes do not have
unintended consequences. For example, neither the care giver nor the recipient of
care should be overburdened with paperwork; in this regard, the use of IT systems
similar to those being introduced by the NHS Wales Informatics Service (NWIS)
for community nurses may be beneficial.
Your views on career structure and development and training
16. Which, if any, of the ideas set out below do you think will offer domiciliary care
workers more opportunities for training, development and progression?
Yes/no
i. As part of the registration process, require all domiciliary care
workers to achieve a qualification such as a Level 2 or Level 3
Diploma in Health and Social Care and require domiciliary care
workers to demonstrate they have taken part in ongoing training
and development.
ii. Develop a ‘career pathway’ for domiciliary care workers. This
would be similar to the career pathway for social workers.
The career pathway would support the development of
domiciliary care workers throughout their careers.
iii. Introduce diversity and specialisms into the role of domiciliary
care work through providing training and development to care
workers to enable them to specialise in working with, for
example, people with dementia, to take on appropriate health
tasks or support roles for adults with drug and alcohol
dependency.
Yes
17. Please use the box below to leave your views about training, development and
progression within domiciliary care
RCN Wales believes that improvements are needed on training, development and
progression for the domiciliary care workforce. As discussed previously, a
programme of Continuous Professional development would have a positive impact
on recruitment and retention.
Registration the Nursing and Midwifery Council would facilitate opportunities for
training and development by establishing links between domiciliary care staff and
an orchestrated training programme. We believe that access to this core training
agenda would benefit workers and ensure that domiciliary care workers in Wales
can access the same standards of training and development as their peers
working in other parts of the UK.
Your views on the occupational status of domiciliary care
work
18. We are doing a number of things to raise the professional status of domiciliary
care workers. Please use the box below to let us know of any other ways we
can improve the status of domiciliary care work
In addition to the educational benefits outlined in section 17, RCN Wales believes
that the occupational status of domiciliary care work would be improved by
introducing a requirement for registration with the NMC. This would enhance the
occupational status of domiciliary care by publicly committing to established
standards of education, training, conduct and performance.
Your views on the health and safety of domiciliary care
workers
19. Which, if any, of our ideas below do you think would work in making sure
domiciliary care workers are safe when they work
Yes/no
I.
II.
Domiciliary care providers must have policies in
place – such as lone worker policies,
communication and mobile phone policies, health
and safety policies
As part of the inspection process, the inspector will make
sure the policies are in place and will check domiciliary care
workers are safe when working
Yes
Yes
20. Please use the box below to tell us about health and safety issues for
domiciliary care workers and any ideas which you think will help keep
domiciliary care workers safe at work
The introduction of a mandatory regime of minimum health and safety training
might be beneficial. Such a programme might include:
- General Health & Safety Awareness
- Lone Working
- Safe Driving
- Infection Control
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